The evolution of evidence-based methods of acute myocardial infarction treatment: is there any reason for optimism in recent years?

Abstract

The article briefly describes the stages of creating the main methods of acute myocardial infarction (MI) and its complications treatment. It is noted that currently existing clinical guidelines (CG) were formed at the end of the first decade of the XXI century; since then there have been no principal changes in the CG due to the lack of fundamentally new approaches to the acute MI treatment, its immediate and long-term outcomes. Compliance with the current CG has significantly reduced hospital mortality in acute MI and improved long-term outcomes. However, today, despite compliance with the CG, the absolute hospital mortality rates for acute MI remain quite high, and the long-term prognosis of patients’ lives is very unfavorable. A number of major randomized clinical trials that ended in 2023-2024 and studied fundamentally new approaches to the treatment of acute MI and its long–term outcomes are analyzed. It is noted that none of these studies gave a positive result. A new study with beta-blockers, which proved its positive effect on the mortality of patients with acute MI in the 80s of the twentieth century, gave negative results. This may indicate that a number of acute MI treatment methods, the effectiveness of which was proven several decades ago, have now lost their significance. It is concluded that despite compliance with modern CG, the residual risk of death after acute MI remains quite high. It is necessary to develop principally new methods of treating this disease.

Keywords

• acute myocardial infarction
• evidence-based therapy
• clinical guidelines
• new methods of treatment
• complete revascilarization
• sglt2 inhibitors
• apolipiprotein a1
• beta-blockers